Prior Authorization Support

The Problem

Prior authorization is one of the biggest administrative burdens in healthcare.

Standard requests take seven to fourteen business days, urgent ones take one to four, and every request means forms, questionnaires, and re-keyed patient data, which delays care and drives up cost. New CMS-0057-F rules put hard deadlines and FHIR-API requirements on payers.

What PAS Does

PAS is Amida's prior authorization solution, built on FHIR and the Da Vinci implementation guides to turn a two-week paperwork cycle into a fast, standards-based exchange between providers and payers, while meeting the CMS-0057-F Final Rule head-on.

It works across three interlocking layers: Coverage Requirements Discovery tells a provider, in real time via CDS hooks, whether a service needs PA and what documentation is required; Documentation Templates and Rules presents a questionnaire that auto-populates from the provider's EHR, eliminating the re-entry that makes PA so painful; and the PAS layer assembles standardized FHIR bundles and transforms X12 278 and 275 for the systems already in place.

The result is compliance and efficiency: payers can customize questionnaire templates in under a day, track requests with overdue notifications, and report volumes, turnaround times, and approval rates, while providers get answers within the seven-day and 72-hour windows CMS now requires, and patients get to care faster.